For-Profit Dialysis Centers Have Higher Mortality Rates, Up To 24%

If you’re a patient at the largest for-profit dialysis chain in America, you’re 19% more likely to end up dying than if you went to a non-profit chain. If you’re at the second-largest for-profit chain, you’re 24% more likely to die. These disturbing results were released in a new study in the Health Services Research journal. Guess if you’re going in for dialsysis, you’ll want to think carefully about your choice of treatment options and don’t forget to include a non-profit center in your selection process.

The Effect of Dialysis Chains on Mortality among Patients Receiving Hemodialysis [Health Services Research]
New Study Shows Higher Mortality Risk at For-Profit Dialysis Chains [ProPublica]

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  1. RosevilleWgn says:

    This is not good news. I’ll have to review my wife’s options.

    • MedicallyNeedy says:

      Go to a transplant center ON YOUR OWN, and get their financial coordinator to be your advocate. Also join a transplant or NKF support group for advice on how to work around the system. I went to a for-profit center and they were wonderful. The staff, the nurses were the best! The social-worker/financial adviser (when they finally hired one) not so much. They hire morons. Medicare pays the for-profits $24,000,000.00+ for every 2 weeks of dialysis when rejection medications are much less. Their best interest is to have you live longer. The for-profits have some of the highest paid lobbyist in DC! It’s much harder to get coverage for an anti-rejection drug then it is for dialysis. It does not make sense. http://www.kidney.org

      • RosevilleWgn says:

        Yep, we know the bandwagon. Unfortunately, last time I checked (Since being 26yo, and reasonably healthy other from the normal hypertension, diabetes and huge potassium issues) she wasn’t very high on the UNOS list. In the 700′s somewhere.

        The current center she’s at charges somewhere around 37K a week, but I don’t know the “level” of care she’s getting. Is it better or worse then the care available elsewhere?

        • MedicallyNeedy says:

          They use to post an average percentage of, I can’t remember if it was overall GFR or creatnin clearance rates for patient, for all centers in the area. I think it’s required by law and is updated monthly. look on the waiting room bulletin board.

    • Jedana says:

      We do home hemodialysis for my husband.

    • Jedana says:

      We do home hemodialysis for my husband.

      • RosevilleWgn says:

        We have opted to NOT get into the housing market until all the crap is said and done, so finding a 240v outlet for a “real” hemodialysis machine is hard to come by in an apartment. ;) Those little portable units are NOT a good idea for long term care.

  2. caoimhinnn says:

    I’m actually surprised by this. For-profit medical facilities should be assuming that data like this will be released and will affect their bottom line. Generally, in my experience, for-profit enterprises (not withstanding those in the medical field) provide a higher quality of service than non-profits, if only because they have the resources to build better facilities and the financial incentives to make their services the most attractive to prospective clients.

    • obits3 says:

      Maybe people don’t value quality in health care (because they don’t use it that much). Thus, people are price sensitive. This means that a for profit would have to charge the same prices as a non-profit. The only way to do that and make a profit would be to hurt quality.

    • Loias supports harsher punishments against corporations says:

      Likely will not affect their bottom line, for two reasons. One, the top two for-profit chains hold a huge majority of the market. In some places 100%. Second, customers are not the one paying for services, the government is paying them. We have in this country socialized dialysis. And the govenrment pays for these services a flat amount, regardless the actual overhead cost. Which is why for-profits have a higher mortality rate. They are not incentivized to provide good service, only cheaper service.

      • Duke_Newcombe-Making children and adults as fat as pigs says:

        After even a cursory R of TFA, I don’t see how you come to that hypothosis. Could it be that since the for-profit dialysis centers control such large “market share”, and in some places (as you point out) are the only game in town, that they’ll also get a larger share of the sicker patients.

        I don’t believe myself saying this (being a believer that private Big Med is doubleplus evil), but we need more information before we are able to pin a particular correlation/causation relationship between the centers and mortality.

        But then again, that wouldn’t make for good Consumerist, would it?

        • LadyTL says:

          Actually there is alot of facts out there supporting that there is a connection between mortality and these private dialysis clinics. It’s mostly due to undertrained staffs and not enough personnel to watch all the people they bring in. Some of the examples you can find are really sickening too.

        • FilthyHarry says:

          Given that we’re dealing with percentages, how does the for-profit segment of the industry having a larger share of the industry explain away their larger percentage mortality rate?

        • Loias supports harsher punishments against corporations says:

          Maybe I should have stated previously, but I have a little more knowledge on the subject beyond this very abstract article.

    • FilthyHarry says:

      You haven’t been paying attention to the market for a long time have you?

      Banks sell mortgages to people who can’t afford them.
      Investment companies sell securities that they know are no good.
      Manufacturers sell products that are physically harmful to their customers.

      The problem with thinking that self-interest will control and correct the market automatically fails to take into account that there is more than one kind of self-interest and they are often conflicting. Short-term self-interest seems to be the winner.

    • ludwigk says:

      This surprises you because you may not be aware of the inelasticities of the medical services market. For a lot of reasons, medical services aren’t effected by typical market forces. Huge information asymmetry, lack of research and understanding of procedures, no competition among players, inability to export service. There are HUGE price disparities, like over 500% for services which are nearly identical, or only have a few % statical improvement over their cheaper counterparts.

      There was a story on NPR about how how you could spend a dozen times as much on the latest MRI, which is only superior at testing for certain conditions (which you may or may not even be getting the MRI for), or go to an independent MRI “Mom and Pop” shop (sole practitioner with a perfectly good MRI machine from a decade ago) which is 5% worse for some conditions, and equal for others. It’s a very odd market that defies everything you learn in Econ 101.

      A lot of this is money-driven as a result of our insurance system.

  3. AI says:

    But public health care is communism! How am I supposed to choose between death and being a dirty red?
    /s

    • caoimhinnn says:

      I wonder though if this is the exception and not the rule. As Areaman says below, the stakeholders in these for profits will apply pressure for them to improve. Otherwise, they will collapse.

      Non-profits and government operations might not have that kind of incentive to provide a superior care. In the event where those facilities offer a poorer quality of service, there’s really no institutional incentive for them to improve. And of course this is why, generally, the private for-profits outperform public NP enterprises.

      • Loias supports harsher punishments against corporations says:

        No, you are very wrong. Stakeholders care about profits, not quality of care.

        • caoimhinnn says:

          Yes, of course they do. But to the extent that a higher quality of care yields more customers and thus profits, they have an interest in providing a higher quality of care.

          Your argument is that because they government pays them regardless, cost-cutting is paramount. That may be true. I don’t know much about dialysis as a private enterprise, so I’ll defer to you.

          • mister_roboto says:

            Highest amount of care at the lowest cost possible with the highest profits possible.

            Who wouldn’t trust them with your life?

          • Loias supports harsher punishments against corporations says:

            Considering part of the problem is that patients can’t look up quality of care reports for different centers, stakeholders have no incentive to do anything for the patient. You can view some very basic information, but you can not look up mortality rates.

            And the proof is right here. Clearly they took cost cutting measure and profits increased. So they did it again. And profits increased. They will continue to do it until it bites them…if it ever bites them. Dialysis Reform Now!

          • OnePumpChump says:

            Wow, that dialysis center provides such excellent service, I think I’ll sell both my kidneys and start patronizing it.

            Demand for dialysis is not particularly elastic.

          • Mecharine says:

            We already have problems with for-profit senior citizen homes. This is not an isolated situation. For-profit health care maximizes profits and minimizes costs, any way deemed legal. There is no moral justification to do anything else as far as corporations and their stock holders care.

  4. Alvis says:

    I use my own kidneys at home.

    • Spike3185 says:

      Gd fr y, sshl. Nt vryn hs tht ptn. G fck yrslf. Srsl.

      • sonneillon says:

        It’s called a joke. Lighten up.

        • RosevilleWgn says:

          It’s not a joke to some people, you know. ESRD is no fun.

          • Loias supports harsher punishments against corporations says:

            You and Spike need to find a different blog then. Because if that’s what sets you off, you’re in for a wild ride here.

            • Cheap Sniveler: Sponsored by JustAnswer.comâ„¢ says:

              Yea, my Grandfather was on a machine till he died.

              That was F’ing funny, dickwad. Spike, you came “this close” to being flagged for review, you humorless pottymouth bastard. But as a believer that everyone has a right to free speech, even morons like you, I let you slide.

              Please, see a doctor and have your sense of humor looked at. I think the have a machine for that now.

          • Alvis says:

            Oh, piss off if you don’t like “X my own Y at home” jokes.

          • sonneillon says:

            I crack jokes about all kinds of things that aren’t fun. Racism, rape, babies the holocaust.

      • DoktorGoku says:

        Surgeon here, very sensitive to people’s ailments.

        You need to chill out and learn to recognize a joke when you see one.

        It’s funny.

        Grow up.

        • ldub says:

          LOL @ seeing “surgeon” and a reference to emotional sensitivity in the same sentence….lol….oh, you guys crack me up!

      • rahntwo says:

        I don’t know if you have any kidneys , but I definitely know you have an asshole. How do I know, you ask? Because you are one, one big huge asshole. If you cant tolerate the jokes here, go find a roll of toilet paper and wipe yourself off the face of the earth. Live with that, SpincterBoy.

    • healthdog says:

      You use both? Pfft. So wasteful. I get by just fine on one.

    • Total Casual says:

      Pshaw, I make new kidneys in my bioreactor at home.

  5. areaman says:

    Have a feeling a lot of people who have no stake in these for profits will get offended and repudiate the findings.

  6. Cheap Sniveler: Sponsored by JustAnswer.comâ„¢ says:

    Bad news is, these places get most of their money from the GubaMint.

    (PBS documentaries rule!)

    • ARP says:

      Funded by government is not government run. Very big difference. As other commenters have noted, since they’re for profit, they tend to reduce the quality of their care if they can’t charge more.

      • Cheap Sniveler: Sponsored by JustAnswer.comâ„¢ says:

        My point: They are just funnels for government money. Yes, big difference.

        • ldub says:

          “They are just funnels for government money” – yep, if the GOP continues to get their way they certainly are.

          • Loias supports harsher punishments against corporations says:

            Actually, if Repuiblicans had their way, they’d cut the funding for dialysis, and tens of thousands of people would die each year from kidney failure, or go bankrupt from medical bills.

  7. weestrom says:

    Yes, by all means, don’t forget to included. (*eyeroll*)

  8. Mike says:

    See, government run healthcare is killing people! Look, this is proof! Wait. This was private run, for profit? Curse you for challenging my world view!

  9. dolemite says:

    That’s because just like everything else in our “for profit” medical system (including insurance), a company’s number ONE concern is making money. If that means you pay less for less qualified nurses, or skimp on some supplies or cut the hours of a few people so they have less time to check on patients so that the company maximizes profits, then you do it. Patient health ranks way below that.

    • Loias supports harsher punishments against corporations says:

      THIS. It’s pretty much the de facto reason for nationalized healthcare.

      • lymer says:

        Because everything is better under nationalized healthcare?

        Nobody is saying that private healthcare is perfect.

        • JulesNoctambule says:

          With nationalized healthcare, I could get medical care. I don’t care how perfect or imperfect private care is when I’m denied the insurance required to participate!

    • dadelus says:

      That’s actually the problem with any “for-profit” venture. Sooner or later the profits become more important then all other concerns and therefore quality suffers while prices remain constant if they don’t actually rise.

      Yes, I realize the answer to this is that competition should enter the market to drive down costs, but in many markets today the barriers to entry are so high that new competitors have little chance of entering the market much less competing with an entrenched oligopoly.

      • RvLeshrac says:

        Corporate law requires that they hold the stock value, and thus profit, above all other concerns. Way above. So far above that it can’t even be seen.

        The only time you don’t have that problem is when dealing with companies whose sole stock-and-trade is information.

  10. ClaudeKabobbing says:

    Seeing as I cannot read the article because I I do not have an account or a subscription, I cannot fully comment on the EVIL of for profit caregivers. What I can say is that my father passed away 1.5 months after starting dialysis at the largest for profit dialysis chain in the country. The chain had nothing to do with it. My father had many other problem and waited until he could no loinger walk and had many other dialysis/kidney related problems to start. His heart could not take the stress of dialysis.

    I would be intersted in the average age, health other factors of for-profit patients as opposed to the non-profit patients before I make a decision.

    • popsnicker says:

      This is a very good point. Many people on dialysis are very sick and ESRD may just be a part of their overall condition. However, all deaths for any reason are tracked in the articles. Maybe the for profit centers are just willing to accept sicker patients even though their scores would suffer for it?

      • shawnamuffin says:

        Dialysis isn’t always about averting death; sometimes it is about prolonging life, and other times it’s about improving the quality of the remaining duration of your life. So, my deduction based on those facts is that you don’t cherry-pick patients to get better death stats because dialysis isn’t always made to save a life in the way, say, C-sections will successfully get an endangered baby out of a womb.

  11. Talisker says:

    For-profit health care facilities are in the business of making a profit for people who want to spend it on something other than health care.

    Not-for-profit health care facilities are in the business of providing medical care, and reinvest their profits back in to providing more health care.

    Seems obvious to me which is likely to provide better care.

  12. framitz says:

    It seems that For Profit = More care for Money than for patient’s welfare…

    Did I get that about right?

  13. Intheknow says:

    People should open their eyes. The x-rays, CT scan, and MRI your doctor wants you to get – likely he has ownership in the center. Dialysis? Same thing. Health care has become ALL about money. The sweet commercials and platitudes are just frosting.

  14. JulesNoctambule says:

    Off topic, but my mom spent part of her childhood in an iron lung like that one, mirror and all. The mirrors were the only way she and the other children could see each other when they talked. Vaccinate your kids, people, because polio sucks even if you survive it.

    • Lexasaurus says:

      Very true. As a kid in the late 80s, I met one of the last people to be still using an iron lung. He’d been in the iron lung since the early 50s. He lived in a nursing home where my mom worked, and he had prism glasses that allowed him to see people in the room (upside-down, but apparently the brain compensates). Although he was only my mom’s age, he’d lived in a nursing home almost his whole life. Vaccinate, vaccinate, vaccinate.

      Also, why *is* there a picture of an iron lung and not a dialysis machine?

    • HogwartsProfessor says:

      Absolutely. My neighbor has post-polio syndrome and it really sucks. She has very limited energy and all kinds of other problems.

      • JulesNoctambule says:

        Mom also has PPS, and it’s the ultimate ‘F YOU’, like it wasn’t enough for polio to steal her childhood.

  15. pwik says:

    Not enough information here to actually draw any conclusions. The “for-profit-has-wose-results” story is always compelling, but what is the reality of the patient base they are serving? Are the people sicker to begin with?

    • bhr says:

      these sorts of “studies” rarely account for outside factors. For example, support systems. My Grandfather was receiving Dialysis at a VA hospital for many years. As part of that he had a system that both reminded him to come each time, and even would pick him up for each appointment. Additionally, since he was in a hospital any outside complaints he had were often checked out.

      Going to a pay for play type system would have cost less (not for him, but for the government) but wouldnt have provided the same system to make sure he kept up treatment, and thus would have likely resulted in an early death.

    • Nigerian prince looking for business partner says:

      I was wondering the same thing. It would be interesting to know the demographics of who is on dialysis. Is it mostly the elderly? Or those with uncontrolled diabetes (previously on Medicaid or w/out insurance)?

  16. MauriceCallidice says:

    “If you’re a patient at the largest for-profit dialysis chain in America, you’re 19% more likely to end up dying than if you went to a non-profit chain.”

    So you’ll be 19% more likely to end up dying than would be with the 100% chance of dying you would have if you went to a non-profit chain?

    What is that, a 119% chance of dying?

  17. rahntwo says:

    The average Renal dialysis treatment costs $6000.00, is performed 3-4 times per week per patient and is totally paid for by the government for 90% of the people receiving treatments. That’s $936,000 per patient per year. Think about that.

    • OnePumpChump says:

      I wonder what it costs in other countries.

      • Cheap Sniveler: Sponsored by JustAnswer.comâ„¢ says:

        “Taxpayers spend more than $20 billion a year to care for those on dialysis—about $77,000 per patient, more, by some accounts, than any other nation. Yet the United States continues to have one of the industrialized world’s highest mortality rates for dialysis care. Even taking into account differences in patient characteristics, studies suggest that if our system performed as well as Italy’s, or France’s, or Japan’s, thousands fewer kidney patients would die each year. “

        • Nigerian prince looking for business partner says:

          It would be interesting to learn more about those statistics. I wonder if the nature of why people have dialysis is different int he US vs. Europe and that may impact the negative outcomes. I suspect diabetes and overall poor health play a role in at least some of the disparity.

        • RosevilleWgn says:

          This is why I don’t have my wife on Medicare for her treatment. We have private insurance (Well, provided by my place of work). I’d rather have her services paid for by the civilian sector then taken out of the government pool of funding that others w/o the options she happens to have. Oddly enough, we are well past the three year mark for “mandatory” Medicare enrollment, so we’ll have to see what happens.

          • Nigerian prince looking for business partner says:

            Though, aren’t you concerned you’re driving up group rates at your office in the process?

          • hansolo247 says:

            Careful.

            Many insurance companies have terms regarding medicare. Namely, they have in their policies that they will pay AS IF you had medicare if you are eligible.

            so, if you have 30 months from eligiblity, and medicare would be primary if you had it…they’ll start paying AS IF it were that way, leaving you with the rest.

    • lianeta says:

      A renal care center might BILL 6,000 per treatment, but the government certainly does not pay $6,000 per treatment. Much, much less than that.

    • MrEvil says:

      Its one of the prices you have to pay for an orderly society. Back in the 70′s when it was deemed that medicare would pay for dialysis, we as a society deemed that people dying simply because they couldn’t afford this technological marvel was unacceptable.

      Same reason we require ERs to provide some manner of treatment for patients regardless if they can pay or not. Society deemed it unacceptable to have the bodies of paupers stacked up like cord wood outside of the morgue because they couldn’t pay for emergency medical care.

      The rest of the industrialized world decided that the benefits to society as a whole outweighed the cost.

      • Nigerian prince looking for business partner says:

        “Same reason we require ERs to provide some manner of treatment for patients regardless if they can pay or not. Society deemed it unacceptable to have the bodies of paupers stacked up like cord wood outside of the morgue because they couldn’t pay for emergency medical care.”

        Ironically, society (the law) says it’s unacceptable that people be turned away from the ER but provides no transparent method of paying for their care. As a result, we all get over charged to make up for those costs.

        My family’s health insurance premium was bumped up 19% for next year, so we’ll be paying over $1,100/month for coverage with a high deductible. It hardly seems worth spending so much money for insurance when the ER is legally obligated to treat us. Might as well not renew our insurance and pocket the savings, and let the hospital charge everyone else more.

    • lchen says:

      Yeah, we should let them all die.
      Seriously, what are you proposing.

    • hansolo247 says:

      That’s not even close. Seriously.

      Medicare pays a little over $200 per treatment.

      Seriously, where did you pull these numbers.

      I did dialysis for 6 years, and read my statements.

  18. Arimer says:
    • Cheap Sniveler: Sponsored by JustAnswer.comâ„¢ says:

      Thank you for the link, I knew I’d read this article before but couldn’t remember where.
      It should be “required reading” – Textbook example of good intentions gone astray.

    • Loias supports harsher punishments against corporations says:

      This is the article to read! I couldn’t find it again.

  19. tekdemon says:

    I don’t think this has much to do with the fact that they’re for profit…it’s that the non-profit centers happen to be inside of hospitals, often large university centers and the like, whereas the privately run ones are conveniently located all over the place. Of course if something goes horribly wrong during dialysis (i.e. the minerals in your blood get so goofed up your heart starts having problems, etc.) you’re obviously gonna have a better chance of surviving if you’re already in a hospital versus being in a small clinic.
    Most people prefer to go to the for profit ones because they’re conveniently located near them. It’s not quite as nice as being in a hospital but if the nearest hospital is an hour and half away it’s damned inconvenient if you need regular dialysis.

  20. EverCynicalTHX says:

    There could be a lot of factors involved in the mortality rate and since I can’t see the actual statistical data without paying a fee I’ll reserve my judgment.

  21. TuxthePenguin says:

    Further in the article:

    “More recent information from the federally funded U.S. Renal Data System [6] (USDRS) shows that large dialysis providers achieve better mortality outcomes than nonchain or hospital-based facilities, the DaVita statement added.”

    Funny how that was buried in the article and not even mentioned here at Consumerist. We have two studies that conflict in their findings.

  22. PBallRaven says:

    My sister went for many years (to a for profit center) after the kidney that I donated failed (it lasted 7 years though, so that’s something). She just got tired of it though, and decided to stop treatments. She would be listed on this report as a “victim” of the for-profit system when it was her own choice.

    • Boberto says:

      I feel awful for your sister, and commend you for making a brave choice in donating.

      I think you may have a point, however non profits (and other contemporaries) that have much better survivability/quality of life, ALSO have Patients that elect to withdraw care (for various reasons).

      And those statistics still bear an ugly truth for the For Profits, none the less.

      Data is data. Whether it be from For Profits, Non Profits or peer Countries. It all points to the fact that For Profits are NOT doing as well as their contemporaries.

  23. Boberto says:

    There are waiting lists at most facilities, due to the fact that ESRD increases 10% year over year. The For Profits (Fresenius/Davita) can wholly afford to compromise safe Patient care over profits. They do this in many ways. Sometimes cutting back on supplies, but most often you will see them do this with staff cutbacks. Chronic under staffing, poor training. Situations that generally create environments with very high staff turnover.

    One Fresenius unit recently furloughed an entire unit’s social workers. The social workers are there (state mandated) to advocate on the patient’s behalf (Any issue, including ones involving conflicts with the dialysis unit itself).

    In the end, it was a decision that paid HUGE dividends for Fresenius, as most of the patients were too ill to advocate for themselves. Patient’s family members (likewise), were too overwhelmed and overburdened. A great example of corporate profits at the expense of human suffering. I could site many more.

    Oversight is quite lax at most state levels, ONLY due to the fact that it is enormously painful AND expensive AND laborious to enforce regulatory compliance, (You see, big corporations have big dollars and hire big lawyers!).

    Forget about Federal enforcement (Medicare pays all costs). The Healthcare Lobbyists are firmly in control of those entities.

    The only thing that brings us hope, is the fact that other countries of the free world provide Dialysis services to their citizenry.

    And in doing so, collect data that is shared among peer groups. Thankfully, we can use that data to see the stark contrast in quality of care, mortality and morbidity.

    The data doesn’t lie.

  24. Nigerian prince looking for business partner says:

    It’s hard to comprehend how we can let Americans get below par care, while at the same time giving free dialysis to illegal immigrants. There’s definitely something wrong with the system.

    http://www.nytimes.com/2010/09/01/health/policy/01grady.html

  25. nickcv says:

    I could argue that the mortality rate at both is 100%. Everyone dies.

  26. peebozi says:

    This study must have been performed by the Socialists of America…otherwise, they’d know that the free market does no wrong.

    why does the author of the study hate America and the free market?